Oklahoma City — Oklahoma is no longer one of the five least-healthy states in the country.

The state is still in the bottom 10, but decreases in the rates of smoking and low birth weight moved it up three spots, to 43rd. Only Utah and Florida had a larger positive change, with each moving up four spots.

The annual America’s Health Rankings report, compiled by United Health Foundation, ranks states on 35 measures related to people’s health behaviors, their communities, health policy, clinical care and health outcomes.

Oklahoma’s smoking rate has dropped more percentage points than any other state’s in recent years, falling from 26.1 percent of adults older than 25 in 2012 to 19.6 percent in 2017. The battle is far from over, however. Oklahoma still ranks 36th on its smoking rate.

The rate of low birth weight also improved, though Oklahoma still ranks only in the middle of the pack. About 7.9 percent of Oklahoma babies were born weighing less than five pounds and eight ounces, placing them at risk of immediate and chronic health problems.

The report also contained some other good news — Oklahoma ranked in the 10 best on the small percentage of residents who drink excessively, health disparities between people with a college education and those with less schooling, and infections with pertussis, also known as whooping cough.

Unfortunately, the rest of the report wasn’t so rosy.

Nationwide, the rate of deaths before age 75, which are more likely to be preventable than deaths of older people, continued to increase. Oklahoma fared poorly on deaths as a result of cancer, heart disease and drug overdoses.

Oklahoma was in the 10 worst when it came to:

• Preventable hospitalizations of older people

• People reporting poor mental and physical health

• People without health insurance

• Children who had received their recommended shots by age 3

The Oklahoma State Department of Health said diabetes, the uninsured rate and children’s immunizations are of particular concern.

“Despite the many challenges facing us, I am encouraged that our employees and our partners across the state continue to work toward improving the health of all Oklahomans and that their efforts are producing results,” Interim Health Commissioner Preston Doerflinger said in a news release. “We know where our focus must be in providing the core services that will make a difference in the lives of all our citizens going forward.”

It isn’t surprising that Oklahoma would have poor results on multiple health measures, said Julie Miller-Cribbs, director of the University of Oklahoma School of Social Work. The state has a high poverty rate, and people living in poverty may not have access to safe places to exercise, healthy food and preventive health care.

Other problems not measured in the rankings, like Oklahoma’s high rates of domestic violence and female incarceration, also make the state sicker, Miller-Cribbs said. Traumatic experiences change how the brain develops, so people who have lived through them are more likely to turn to unhealthy coping strategies like smoking and overeating.

“All of these things sort of wind together to produce an unhealthy environment,” she said.

Because Oklahoma’s health problems have roots in many issues, solutions will need to cross many disciplines, she said. Fortunately, the state is already making some efforts, like using drug courts to steer more people toward treatment and setting up programs to prevent child abuse.

“We have some promising programs in our state that we just need to continue to fund,” she said.